Healthcare Provider Details

I. General information

NPI: 1285570770
Provider Name (Legal Business Name): ATHINA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MINERS RD STE C
SAINT JOSEPH MI
49085-9709
US

IV. Provider business mailing address

PO BOX 47
BERRIEN SPRINGS MI
49103-0047
US

V. Phone/Fax

Practice location:
  • Phone: 269-235-9083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: